Prof. Diane De Neubourg
Center for Reproductive Medicine - Antwerp University Hospital
Can we further reduce multiple pregnancies in Belgium?
Prof. Diane De Neubourg
Center for Reproductive Medicine - Antwerp University Hospital
On behalf of the College of Physicians for Reproductive Medicine.
BSRM 1 12 2017
OUTLINE
• What is the actual situation?
• Where are we compared to Europe (EIM 2013)?
• Can we do better? Scope for improvement?
• Analysis of the “remaining twins”
• Conclusions & recommendations
What is the actual situation?
Belrap data 2015
Own fresh cycles 2015: number of deliveries
Own cryo cycles 2015: number of deliveries
6% twins
Fresh and thawed oocyte recipient cycles 2015:
number of deliveries
Fresh Thawed
Fresh and thawed oocyte recipient cycles 2015:
number of deliveries
Where are we compared to Europe?
Assisted reproductive technology in Europe 2013: results generated from European registers by ESHRE
By the European IVF-monitoring consortium (EIM) for ESHRE
Calhaz-Jorge et al., Hum Reprod 2017, 32; 10: 1957-73.
Calhaz-Jorge et al., Hum Reprod 2017, 32: 1957-73
Calhaz-Jorge et al., Hum Reprod 2017, 32: 1957-73
What about the remainig twins?
Analysis of the Belrap data 2010-2015
Fresh cycles
Number of twins (absolute figures)
2010-2015
Rank of the cycle
Age category (<36; 36-37; 38-39; 40-42)
Day of transfer (cleavage stage versus blastocyst stage)
Twin births after a previous IVF birth.
Fresh cycles
Percentage of twin births compared to all births
2010-2015
Rank of the cycle
Age category (<36; 36-37; 38-39; 40-42)
Day of transfer (cleavage stage versus blastocyst
stage)
Cryo cycles
Number of twins (absolute figures)
2010-2015
Rank of the cycle
Age category (<36; 36-37; 38-39; 40-42)
Twin births after a previous IVF birth.
Cryo cycles
Percentage of twin births compared to all births
2010-2015
Age category (<36; 36-37; 38-39; 40-42)
Conclusions
Own fresh cycles (2010-2015)
The highest number of twin births are in the age category <36 in all the cycle ranks and in age category 36-39 in first and second cycles.
Multiple birth rate remains high in all age categories until 40 (range 10-20% over all ranks).
Most twin births still come from cleavage stage embryos, but the proportion twin births after D2-3 versus D5-6 is changing.
Multiple birth rate after D5-6 transfer is higher than on D2-3 high in all age categories.
There is an important number of twin births in 2015 after a previous IVF live birth (2010-2015) particularly in <36 age group.
Conclusions
Own cryo cycles (2010-2015)
The highest number of twin births are in the age category <36 with an important number of twin births after a previous IVF pregnancy.
Multiple birth rate is more or less the same in all age categories until 42 years of age (range 7-10%).
Recommendations
SET for women <36
• at least in first 3 to 4 fresh cycles
• all cryo cycles
• D5 transfer
• After a previous IVF birth
SET for women 36-39 in first 2 fresh cycles (consider in cryo cycles and after a previous birth).
Bear in mind that the twin birth rate is high for all age categories until 40 (42) when counselling the individual patient!
